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A case of ventricular septal defect associated with active infective endocarditis which was successfully treated by triple valve replacement and ventricular septal defect patch closure

A case of ventricular septal defect associated with active infective endocarditis which was successfully treated by triple valve replacement and ventricular septal defect patch closure

Kokyu to Junkan. Respiration & Circulation 39(10): 1049-1053

A 47-year-old man was hospitalized in May, 1990, because of breathlessness and continuous fever which appeared about 4 weeks after he had his periodonitic tooth removed in December, 1989. He had been diagnosed as having ventricular septal defect (VSD) at the age of 6 years. When he was hospitalized, he was in a condition of class IV by NYHA classification, with a white blood cell count of 17,300/mm3, an increase in CRP, a red blood cell sedimentation rate of 108 mm/hr, and positive .alpha.-streptococcus in blood culture. His cardiothoracic ratio was 64% with signs of pulmonary congestion of a chest X-ray film. Echocardiography revealed the presence of VSD and hugh vegetations on the tricuspid, mitral and aortic valves. He was considered to have active infective endocarditis (AIE) which had presumably been provoked by VSD and the tooth removal. Penicillin G at a daily dose of 20 million units and gentamicin at a daily dose of 80 mg were intravenously administered to treat the .alpha.-streptococcus infection for about 4 weeks. Furosemide was used for congestive heart failure. Since, although his cardiac function appeared to have been improved, the signs and symptoms of the infection persisted, triple valve replacement for the tricuspid, mitral and aortic valves and patch closure of the VSD were performed 4 weeks after the hospitalization. The operation revealed inflammatory lesions extending from the endocardium of the right ventricle to the mitral valves through the VSD, and hugh-vegetations on the tricuspid, mitral and aortic valves. The operation was successful and the inflammatory areas gradually disappeared. Thus, the clinical course of the present case suggests that surgical procedures are desirable for treating AIE which is resistant to medical treatment, threatening to cause thromboembolism in major organs.

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Accession: 006933515

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PMID: 1745871

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